COMMUNITY HEALTH NURSING Scope of CHN

Safe and Quality Care, Health Education, and Communication, Collaboration and Teamwork: 1. Principles and Standard of CHN 2. Levels of care 3. Types of Clientele 4. Health Care Delivery System 5. PHC as a Strategy 6. Family-based Nursing Services(Family Health Nursing Process) 7. Population Group-based Nursing Services 8. Community-based Nursing Services/Community Health Nursing Process 9. Community Organizing 10. Public Health Programs

HISTORY OF CHN
Date Event 1901- Act # 157 ( Board of Health of the Philippines); Act # 309 ( Provincial and Municipal Boards of Health) were created. 1905- Board of Health was abolished; functions were transferred to the Bureau of Health. 1912 Act # 2156 or Fajardo Act created the Sanitary Divisions, the forerunners of present MHOs; male nurses performs the functions of doctors 1919 Act # 2808 (Nurses Law was created) Carmen del Rosario, 1 st Fil. Nurse supervisor under Bureau of Health Oct. 22, 1922 Filipino Nurses Organization (Philippine Nurses Organization) was organized. 1923 Zamboanga General Hospital School of Nursing & Baguio General Hospital were established; other government schools of nursing were organized several years after. 1928 - 1st Nursing convention was held 1940 Manila Health Department was created.

1941 Dr. Mariano Icasiano became the first city health officer; Office of Nursing was created through the effort of Vicenta Ponce (CN) and Rosario Ordiz (aCN) Dec. 8, 1941 Victims of World War II were treated by the nurses of Manila. July 1942 Nursing Office was created; Dr. Eusebio Aguilar helped in the release of 31 Filipino nurses in Bilibid Prison as prisoners of war by the Japanese. Feb. 1946 Number of nurses decreased from 556 308. 1948 First training center of the Bureau of Health was organized by the Pasay City Health Department. Trinidad Gomez, Marcela Gabatin, Costancia Tuazon, Ms. Bugarin, Ms. Ramos, and Zenaida Nisce composed the training staff. 1950 Rural Health Demonstration and Training Center was created. 1953 The first 81 rural health units were organized. 1957 RA 1891 amended some sections of RA 1082 and created the eight categories of rural health unit causing an increase in the demand for the community health personnel. 1958-1965 Division of Nursing was abolished (RA 977) and Reorganization Act (EO 288) 1961 Annie Sand organized the National League of Nurses of DOH. 1967 Zenaida Nisce became the nursing program supervisor and consultant on the six special diseases (TB, leprosy, V.D., cancer, filariasis, and mental health illness). 1975 Scope of responsibility of nurses and midwives became wider due to restructuring of the health care delivery system. 1976-1986 The need for Rural Health Practice Program was implemented. 1990- 1992- Local Government Code of 1991 (RA 7160) 1993-1998 Office of Nursing did not materialize in spite of persistent recommendation of the officers, board members, and advisers of the National League of Nurses Inc. Jan. 1999 Nelia Hizon was positioned as the nursing adviser at the Office of Public Health Services through Department Order # 29. May 24, 1999 EO # 102, which redirects the functions and operations of DOH, was signed by former President Joseph Estrada.

LAWS AFFECTING PUBLIC HEALTH AND PRACTICE OF COMMUNITY HEALTH NURSING

R.A. 7160 - or the Local Government Code. This involves the devolution of powers, functions and responsibilities to the local government both rural & urban.The Code aims to transform local government units into self-reliant communities and active partners in the attainment of national goals thru a more responsive and accountable local government structure instituted thru a system of decentralization. Hence, each province, city and municipality has a LOCAL HEALTH BOARD ( LHB ) which is mandated to propose annual budgetary allocations for the operation and maintenance of their own health facilities. Composition of LHB Provincial Level 1. Governor- chair 2. Provincial Health Officer vice chair 3. Chair , Committee on Health of Sangguniang Panlalawigan 4. DOH rep. 5. NGO rep. City and Municipal Level 1. Mayor chair 2. MHO vice chair 3. Chair, Committee on Health of Sangguniang Bayan 4. DOH rep 5. NGO rep EFFECTIVE LHS DEPENDS ON: 1. the LGUs financial capability 2. a dynamic and responsive political leadership 3. community empowerment

P.D. No. 965 requires applicants for marriage license to receive instructions on family planning and responsible parenthood. P.D. NO. 79 defines , objectives, duties and functions of POPCOM RA 4073 advocates home treatment for leprosy Letter of Instruction No. 949 legal basis of PHC dated OCT. 19, 1979 promotes development of health programs on the community level RA 3573 requires reporting of all cases of communicable diseases and administration of prophylaxis

Ministry Circular No. 2 of 1986 includes AIDS as notifiable disease R.A. 7875 National Health Insurance Act R.A. 7432 Senior Citizens Act R.A. 7719 National Blood Services Act R.A. 8172 Salt Iodization Act ( ASIN LAW) R.A. 7277 Magna Carta for PWDs, provides their rehabilitation, self-development and selfreliance and integration into the mainstream of society R.A. 7875 National Health Insurance Act R.A. 7432 Senior Citizens Act R.A. 7719 National Blood Services Act R.A. 8172 Salt Iodization Act ( ASIN LAW) R.A. 7277 Magna Carta for PWDs, provides their rehabilitation, self-development and selfreliance and integration into the mainstream of society A. O. No. 2005-0014- National Policies on Infant and Young Child Feeding: 1. All newborns be breastfeed within 1 hr after birth 2. Infants be exclusively breastfeed for 6 mos. 3. Infants be given timely, adequate and safe complementary foods 4. Breastfeeding be continued up to 2 years and beyond E.O. 51- Phil. Code of Marketing of Breastmilk Substitutes R.A. 7600 Rooming In and Breastfeeding Act of 1992 R.A. 8976 Food Fortification Law R.A. 8980 promulgates a comprehensive policy and a national system for ECCD A..O. No. 2006- 0015- defines the Implementing guidelines on Hepatitis B Immunization for Infants R.A. 7846- mandates Compulsory Hepatitis B Immunization among infants and children less than 8 yrs old R.A. 2029- mandates Liver Cancer and Hepatitis B Awareness Month Act ( February) A.O. No. 2006-0012- specifies the Revised Implementing Rules and Regulations of E.O. 51 or Milk Code, Relevant International Agreements, Penalizing Violations thereof and for other purposes

Community Health Nursing

special field of nursing that combines skills of nursing, public health and some phases of social assistance and functions as part of the total public health program for the promotion of health, the improvement of the conditions in the social and physical environment, rehabilitation of illness and disability (WHO Expert Committee of Nursing) learned practice discipline with the ultimate goal of contributing as individuals and in collaboration with others to the promotion of the clients optimum level of functioning thru teaching and delivery of care ( Jacobson ) a service rendered by a professional nurse to IFCs, population groups in health centers, clinics, schools , workplace for the promotion of health, prevention of illness, care of the sick at home and rehabilitation (DR. Ruth B. Freeman)

Concepts
The primary focus of community health nursing is health promotion. Community health nurses provide care necessary to meet the requirements of an individual all throughout the life cycle. Knowledge on different fields (biological and social sciences, clinical nursing, and community health organizations) is used. Nursing process in community health nursing changes based on the needs of the community.

GOAL

To elevate the level of health of the multitude.

PHILOSOPHY Worth and dignity of man.

PRINCIPLES 1. The need of the community is the basis of community health nursing. 2. The community health nurse must understand fully the objectives and policies of the agency she represents. 3. The family is the unit of service. 4. CHN must be available to all regardless of race, creed and socioeconomic status 5. The CHN works as a member of the health team 6. There must be provision for periodic evaluation of community health nursing services 7. Opportunities for continuing staff education programs for nurses must be provided by the community health nursing agency and the CHN as well 8. The CHN makes use of available community health resources 9. The CHN taps the already existing active organized groups in the community 10. There must be provision for educative supervision in community health nursing 11. There should be accurate recording and reporting in community health nursing 12. Health teaching is the primary responsibility of the community health nurse

Standards in CHN
I. Theory Applies theoretical concepts as basis for decisions in practice

II. Data Collection Gathers comprehensive , accurate data systematically

III. Diagnosis Analyzes collected data to determine the needs/ health problems of IFC

IV. Planning At each level of prevention, develops plans that specify nursing actions unique to needs of clients

V. Intervention Guided by the plan, intervenes to promote, maintain or restore health, prevent illness and institute rehabilitation VI. Evaluation Evaluates responses of clients to interventions to note progress toward goal achievement, revise data base, diagnoses and plan

VII. Quality Assurance and Professional Development Participates in peer review and other means of evaluation to assure quality of nursing practice Assumes professional development Contributes to development of others

VIII. Interdisciplinary Collaboration Collaborates with other members of the health team, professionals and community representatives in assessing, planning, implementing and evaluating programs for community health

XI. Research Indulges in research to contribute to theory and practice in community health nursing

LEVELS OF CARE/ PREVENTION 1. PRIMARY 2. SECONDARY 3. TERTIARY Types of Clientele: 1. INDIVIDUALS 2. FAMILIES 3. COMMUNITIES

4. POPULATION GROUPS Aggregate of people who share common characteristics, developmental stage or common exposure to particular environmental factors thus resulting in common health problems ( Clark, 1995:5) e.g. children . elderly, women, workers etc.

Phil. Health Care Delivery System 1. PRIMARY LEVEL FACILITIES 2. SECONDARY LEVEL FACILITIES 3. TERTIARY LEVEL FACILITIES THE DEPARTMENT OF HEALTH VISION: Health for all Filipinos MISSION: Ensure accessibility & quality of health care to improve the quality of life of all Filipinos, especially the poor. NATIONAL OBJECTIVES :

1. Improve the general health status of the population (reduce infant mortality rate, reduce child morality rate, reduce maternal mortality rate, reduce total fertility rate, increase life expectancy & the quality of life years).

2. Reduce morbidity, mortality, disability & complications Diarrheas, Pneumonias, Tuberculosis, Dengue, Intestinal Parasitism, Sexually Transmitted Diseases, Hepatitis B, Accident & Injuries, Dental Caries & Periodontal Diseases, Cardiovascular Diseases, Cancer, Diabetes, Asthma & Chronic Obstructive Pulmonary Diseases, Nephritis & Chronic Kidney Diseases, Mental Disorders, Protein Energy Malnutrition, Iron Deficiency Anemia & Obesity.

3. Eliminate the ff. diseases as public health problems: Schistosomiasis Malaria Filariasis Leprosy Rabies Measles

Tetanus Diphtheria & Pertussis Vitamin A Deficiency & Iodine Deficiency Disorders

4. Eradicate Poliomyelitis 5. Promote healthy lifestyle through healthy diet & nutrition, physical activity & fitness, personal hygiene, mental health & less stressful life & prevent violent & risk-taking behaviors.

6. Promote the health & nutrition of families & special populations through child, adolescent & youth, adult health, womens health, health of older persons, health of indigenous people, health of migrant workers and health of different disabled persons and of the rural & urban poor

7. Promote environmental health and sustainable development through the promotion and maintenance of healthy homes, schools, workplaces, establishments and communities towns and cities. Basic Principles to Achieve Improvement in Health 1. Universal access to basic health services must be ensured. 2. The health and nutrition of vulnerable groups must be prioritized. 3. The epidemiological shift from infection to degenerative diseases must be managed. 4. The performance of the health sector must be enhanced. Primary Strategies to Achieve Goals 1. Increasing investment for Primary Health Care. 2. Development of national standards and objectives for health. 3. Assurance of health care. 4. Support to the local system development. 5. Support for frontline health workers PRIMARY HEALTH CARE (PHC) May 1977- 30th World Health Assembly decided that the main health target of the government and WHO is the attainment of a level of health that would permit them to lead a socially and economically productive life by the year 2000.

September 6-12, 1978 - First International Conference on PHC in Alma Ata, Russia (USSR) The Alma Ata Declaration stated that PHC was the key to attain the health for all goal October 19, 1979 - Letter of Instruction (LOI) 949), the legal basis of PHC was signed by Pres. Ferdinand E. Marcos, which adopted PHC as an approach towards the design, development and implementation of programs focusing on health development at community level.

RATIONALE FOR ADOPTING PRIMARY HEALTH CARE: Magnitude of Health Problems Inadequate and unequal distribution of health resources Increasing cost of medical care Isolation of health care activities from other development activities

DEFINITION OF PRIMARY HEALTH CARE : essential health care made universally accessible to individuals and families in the community by means acceptable to them, through their full participation and at cost that the community can afford at every stage of development. a practical approach to making health benefits within the reach of all people. an approach to health development, which is carried out through a set of activities and whose ultimate aim is the continuous improvement and maintenance of health status of the community. GOAL OF PRIMARY HEALTH CARE: HEALTH FOR ALL FILIPINOS by the year 2000 AND HEALTH IN THE HANDS OF THE PEOPLE by the year 2020

An improved state of health and quality of life for all people attained through SELF-RELIANCE. KEY STRATEGY TO ACHIEVE THE GOAL:

Partnership with and Empowerment of the people - permeate as the core strategy in the effective provision of essential health services that are community based, accessible, acceptable, and sustainable, at a cost, which the community and the government can afford. OBJECTIVES OF PRIMARY HEALTH CARE Improvement in the level of health care of the community Favorable population growth structure

 Reduction in the prevalence of preventable, communicable and other disease. Reduction in morbidity and mortality rates especially among infants and children. Extension of essential health services with priority given to the underserved sectors. Improvement in Basic Sanitation Development of the capability of the community aimed at self-reliance. Maximizing the contribution of the other sectors for the social and economic development of the community. MISSION: To strengthen the health care system by increasing opportunities and supporting the conditions wherein people will manage their own health care. TWO LEVELS OF PRIMARY HEALTH CARE WORKERS 1. Barangay Health Workers - trained community health workers or health auxiliary volunteers or traditional birth attendants or healers. 2. Intermediate level health workers include the Public Health Nurse, Rural Sanitary Inspector and midwives. PRINCIPLES OF PRIMARY HEALTH CARE 1. 4 A's = Accessibility, Availability, Affordability & Acceptability, Appropriateness of health services. The health services should be present where the supposed recipients are. They should make use of the available resources within the community, wherein the focus would be more on health promotion and prevention of illness. 2. COMMUNITY PARTICIPATION =heart and soul of PHC 3. People are the center, object and subject of development. Thus, the success of any undertaking that aims at serving the people is dependent on peoples participation at all levels of decision-making; planning, implementing, monitoring and evaluating. Any undertaking must also be based on the peoples needs and problems (PCF, 1990) Part of the peoples participation is the partnership between the community and the agencies found in the community; social mobilization and decentralization. In general, health work should start from where the people are and building on what they have. Example: Scheduling of Barangay Health Workers in the health center

BARRIERS OF COMMUNITY INVOLVEMENT Lack of motivation Attitude Resistance to change Dependence on the part of community people Lack of managerial skills

4. SELF-RELIANCE 5. Partnership between the community and the health agencies in the provision of quality of life. Providing linkages between the government and the non-government organization and peoples organization.

6. Recognition of interrelationship between the health and development HEALTH is not merely the absence of disease neither it is only a state of physical and mental well-being Is a social phenomenon recognizes the interplay of political, socio-cultural and economic factors as its determinant. Good Health therefore, is manifested by the progressive improvements in the living conditions and quality of life enjoyed by the community residents

DEVELOPMENT is the quest for an improved quality of life for all. is multi-dimensional. It has a political, social, cultural, institutional and environmental dimensions(Gonzales 1994). Therefore, it is measured by the ability of people to satisfy their basic needs.

7. SOCIAL MOBILIZATION It enhances people participation or governance, support system provided by the Government, networking and developing secondary leaders.

8. DECENTRALIZATION

MAJOR STRATEGIES OF PRIMARY HEALTH CARE A. ELEVATING HEALTH TO A COMPREHENSIVE AND SUSTAINED NATIONAL EFFORTS. Attaining Health for all Filipino will require expanding participation in health and health related programs whether as service provider or beneficiary. Empowerment to parents, families and communities to make decisions of their health is really the desired outcome. Advocacy must be directed to National and Local policy making to elicit support and commitment to major health concerns through legislations, budgetary and logistical considerations. B. PROMOTING AND SUPPORTING COMMUNITY MANAGED HEALTH CARE C. INCREASING EFFICIENCIES IN THE HEALTH SECTOR Using appropriate technology will make services and resources required for their delivery, effective, affordable, accessible and culturally acceptable. The development of human resources must correspond to the actual needs of the nation and the policies it upholds such as PHC. The DOH will continue to support and assist both public and private institutions particularly in faculty development, enhancement of relevant curricula and development of standard teaching materials.

D. ADVANCING ESSENTIAL NATIONAL HEALTH RESEARCH Essential National Health Research (ENHR) is an integrated strategy for organizing and managing research using intersectoral, multi-disciplinary and scientific approach to health programming and delivery.

4 CORNERSTONES/ PILLARS IN PRIMARY HEALTH CARE 1. Active Community Participation 2. Intra and Inter-sectoral Linkages 3. Use of Appropriate Technology 4. Support mechanism made available HERBAL MEDICINES ENDORSED BY THE DEPARTMENT OF HEALTH ELEMENTS OF PRIMARY HEALTH CARE: Education For Health Is one of the potent methodologies for information dissemination. It promotes the partnership of both the family members and health workers in the promotion of health as well as prevention of illness.

Locally Endemic Disease Control The control of endemic disease focuses on the prevention of its occurrence to reduce morbidity rate. Example Malaria Control and Schistosomiasis Control Expanded Program on Immunization This program exists to control the occurrence of preventable illnesses especially of children below 6 years old. Immunizations on poliomyelitis, measles, tetanus, diphtheria and other preventable disease are given for free by the government and ongoing program of the DOH Maternal and Child Health and Family Planning The mother and child are the most delicate members of the community. So the protection of the mother and child to illness and other risks would ensure good health for the community. The goal of Family Planning includes spacing of children and responsible parenthood. Environmental Sanitation and Promotion of Safe Water Supply Environmental Sanitation is defined as the study of all factors in the mans environment, which exercise or may exercise deleterious effect on his well-being and survival. Water is a basic need for life and one factor in mans environment. Water is necessary for the maintenance of healthy lifestyle. Safe Water and Sanitation is necessary for basic promotion of health. Nutrition and Promotion of Adequate Food Supply One basic need of the family is food. And if food is properly prepared then one may be assured healthy family. There are many food resources found in the communities but because of faulty preparation and lack of knowledge regarding proper food planning, Malnutrition is one of the problems that we have in the country. Treatment of Communicable Diseases and Common Illness The diseases spread through direct contact pose a great risk to those who can be infected. Tuberculosis is one of the communicable diseases continuously occupies the top ten causes of death. Most communicable diseases are also preventable. The Government focuses on the prevention, control and treatment of these illnesses.

Supply of Essential Drugs This focuses on the information campaign on the utilization and acquisition of drugs. In response to this campaign, the GENERIC ACT of the Philippines is enacted . It includes the following drugs: Cotrimoxazole, Paracetamol, Amoxicillin, Oresol, Nifedipine, Rifampicin, INH(isoniazid) and Pyrazinamide, Ethambutol, Streptomycin, Albendazole, Quinine FAMILY HEALTH NURSING that level of CHN practice directed to the FAMILY as the unit of care with HEALTH as the goal and NURSING as the medium, channel or provider of care

Stages of Family Life Cycle 1. Newly married couple 2. Childbearing 3. Preschool age 4. School-age 5. Teenage 6. Launching 7. Middle-aged ( empty nest retirement) 8. Period from retirement to Death of both spouses HEALTH TASKS OF THE FAMILY 1. recognizing interruptions of health or development 2. seeking health care 3. managing health and non-health crises 4. providing nursing care to the sick, disabled and dependent member of the family 5. maintaining a home environment conducive to good health and personal development 6. maintaining a reciprocal relationship with the community and health institutions

Nurses Roles in Family Health Nursing

1. HEALTH MONITOR 2. PROVIDER OF CARE TO A SICK FAMILY MEMBER

3. COORDINATOR OF FAMILY SERVICES 4. FACILITATOR 5. TEACHER 6. COUNSELOR INITIAL DATA BASE FOR FAMILY NURSING PRACTICE Family structure, Characteristics, an Dynamics 1. Members of the household and relationship to the head of the family 2. Demographic data age, sex, civil status, position in the family 3. Place of residence of each member whether living with the family or elsewhere 4. Type of family structure e.g. matriarchal or patriarchal, nuclear or extended 5. Dominant family members in terms of decision-making, especially in matters of health care 6. General family relationship/dynamics presence of any readily observable conflict between members; characteristics communication patterns among members Socio-economic and Cultural Characteristics 1. Income and Expenses Occupation, place of work and income of each working members Adequacy to meet basic necessities Who makes decisions about money and how it is spent

2. Educational attainment of each other 3. Ethnic background and religious affiliation 4. Significant Others role(s) they play in familys life 5. Relationship of the family to larger community Nature and extent of participation of the family in community activities

 Home and Environment 1. Housing Adequacy of living peace Sleeping arrangement Presence of breeding or resting sites of vectors of diseases Presence of accidents hazards Food storage and cooking facilities Water supply source, ownership, portability Toilet facility type, ownership, sanitary condition Drainage system type, sanitary condition Kind of neighborhood, e.g. congested, slum, etc. Social and health facilities available Communication and transportation facilities available

2. Health Status of each Family Member Medical and nursing history indicating current or past significant illnesses or beliefs and practices conducive to health illness Nutritional assessment 1. Anthropometric data: Measures of nutritional status of children, weight, height, mid-upper arm circumference: Risk assessment measures of obesity: body mass index, waist circumference, waist hip ratio 2. Dietary history specifying quality and quantity of food/nutrient intake per day 3. Eating/ feeding habits/ practices Developmental assessments of infants, toddlers, and preschoolers e.g., Metro Manila Risk factor assessment indicating presence of major and contributing modifiable risk factors for specific lifestyles, cigarette smoking, elevated blood lipids, obesity, diabetes mellitus, inadequate fiber intake, stress, alcohol drinking and other substance abuse Physical assessment indicating presence of illness state/s

Results of laboratory/ diagnostic and other screening procedures supportive of assessment findings

Values, Habits, Practices on Health Promotion, Maintenance and Disease Prevention. Examples include: 1. Immunization status of family members 2. Healthy lifestyle practices. Specify. 3. Adequacy of: rest and sleep exercise use of protective measures- e.g. adequate footwear in parasite-infested areas; relaxation and other stress management activities

4. Use of promotive-preventive health services

HERBAL MEDICINES ENDORSED BY THE DEPARTMENT OF HEALTH

Naime
Five-leaf Chaste tree (Lagundi)

Indications Dosage
1.

2.
3. 4.

Asthma Cough Body Pain Fever

Divide the decoction into 3 parts: For asthma and cough, drink 1 part 3 times a day. For fever and body pains, drink 1 part every 4 hrs.

Marsh-Mint; Peppermint (Yerba Buena)

1.

Body pain

Divide decoction into 2 parts and drink 1 part every 3 hours.

Sambong

1. 2.

Swelling Inducing diuresis (antiurolithiasis)

Divide decoction into 3 parts and drink 1 part 3 times a day.

Tsaang Gubat

1.

Stomachache

Ulasimang Bato/PansitPansitan

1.

Gouty Arthritis

Drink the warm decoction. If it persists, or if there is no improvement an hour after drinking the decoction, consult a doctor. Divide the decoction into 3 parts and drink 1 part 3 times a day after meals.

Garlic

1. 2.

Hypertension Hyperlipidemia Ascariasis

Eat 6 cloves of garlic together with meals

NiyogNiyogan

1.

Chew and swallow only dried seeds 2 hours after dinner according to the following:

ADULTS = 8-10 seeds 9-12 y/o = 6-7 seeds 6-8 y/o = 5-6 seeds

4-5 y/o = 4-5 seeds

Guava

1.

2.

Cleaning wounds Mouth wash for mouth infection, sore gums & tooth decay

For wound cleaning, use decoction for washing the wound 2 times a day For tooth decay and swelling of gums, gargle with warm decoction 3 times a day

Akapulko

1.

2.

Ring worm Athletes foot Scabies

3.

Apply the juice on the affected area 1 to 2 times a day If the person develops an allergy while using the above preparation, prepare the following: oPut 1 cup of chopped fresh leaves in an earthen jar. Pour in 2 glasses of water and cover it. oBoil the mixture until the 2 glasses of water originally poured have been reduced to 1 glass of water oStrain the mixture. Use it while it is warm. oApply the warm decoction on the affected area 1 to 2 times a day.

Bitter Gourd/ Melon (Ampalaya)

1.

Mild NonInsulin Dependent Diabetes Mellitus

Drink cup of cooled or warm decoction 3 times a day after meals.

Ginger
(Zingiber officinale)

1.

Motion sickness, sore throat, nausea & vomiting, migraine headaches, arthritis

An abortifacient if taken in large amounts; should not be used by persons with cholelithiasis unless directed by the physician; may increase the risk of bleeding when used concurrently with anticoagulants & antiplatelets.

Chop and Mash a piece of ginger root, and mix in a glass of water Boil the mixture Drink the cooled or warm decoction as needed.